7. Insertion

The location and angles at which each mini implant is inserted determine the position of its head (for attachment purposes) and should also be planned to avoid root proximity and maximise the bone quantity around the body. The implant may be inserted manually using either the standard screwdriver, or mechanically using the screwdriver mini insert in a contra angle handpiece. The standard screwdriver (DB10-0021) is used for most buccal insertions, whilst the mini screwdriver (DB10-0025) or mini screwdriver insert (DB10-0026) used in a speed reduction (e.g. 128:1) handpiece is recommended in palatal areas and in the posterior alveolus. The principles, similar for both, are as
follows:

i) Using light pressure, and without directly touching the mini-implant threads, lock the screwdriver securely onto the head of the Infinitas mini implant.

ii) The tip of the mini implant is placed onto the mucosa or exposed cortical surface at the desired position and 3D orientation. If a stent is used then this positional information will be dictated by the engagement of the screwdriver within the guidance cylinder. The mini implant is slowly inserted by rotating the screwdriver handle clockwise with one's fingers and with firm seating pressure at the base of the handle. It is essential that one's wrist is stabilised and that the rotations are produced by digit movements only. If the mini screwdriver is used, the handle is twisted clockwise with firm seating pressure applied with the contralateral forefinger. Firm pressure is used to penetrate the cortical plate, but once resistance lessens then the mini implant should be inserted primarily by rotational means.

iii) As the mini implant is gradually advanced through cancellous bone then the torque felt by the clinician will most likely begin to increase, especially in the mandible. In such circumstance the insertion should either be paused for 10 to 20 seconds ( allowing the viscoelastic bone to expand around the mini implant), or the mini implant should be unscrewed by 1 to 2 anticlockwise turns before inserting it further as normal. These measures may be repeated as often as necessary. Excessive resistance may result in either implant fracture or microscopic bone damage.

When a speed reduction contra angle handpiece is used care should be taken not to exceed 100 RPM, to avoid microscopic bone necrosis. The Infinitas mini implant should be inserted such that the top section of its body firmly engages the cortical plate, whilst the neck lightly depresses the mucosa, leaving the head fully accessible (yet not prominent). Notably, if primary stability is unsatisfactory then the mini implant should be removed and the insertion process repeated at a different site. Also, it may be useful to take a radiograph to check the mini implant position in relation to adjacent structures, especially if the patient felt discomfort and/or the adjacent teeth are tender to percussion, and re-position it if necessary.